RESUMEN
OBJECTIVE: Hyperammonemia induced by valproate (VPA) treatment may lead to several neurological and systemic symptoms as well as to seizure exacerbation. Gait instability and recurrent falls are rarely mentioned as symptoms, especially not as predominant ones. METHODS: We report five adult patients with frontal lobe epilepsy (FLE) who were treated with VPA and in whom a primary adverse effect was unstable gait and falls. RESULTS: There were four males and one female patients with FLE, 25-42-year-old, three following epilepsy surgery. All of them were treated with antiepileptic drug polytherapy. Gait instability with falls was one of the principal sequelae of the treatment. Patients also exhibited mild encephalopathy (all patients) and flapping tremor (three patients) that developed following the addition of VPA (three patients) and with chronic VPA treatment (two patients). VPA levels were within the reference range. Serum ammonia levels were significantly elevated (291-407 µmole/L, normal 20-85) with normal or slightly elevated liver enzymes. VPA dose reduction or discontinuation led to the return of ammonia levels to normal and resolution of the clinical symptoms, including seizures, which disappeared in two patients and either decreased in frequency or became shorter in duration in the other three. CONCLUSIONS: Gait instability due to hyperammonemia and VPA treatment is probably under-recognized in many patients. It can develop when the VPA levels are within the reference range and with normal or slightly elevated liver enzymes.
Asunto(s)
Amoníaco/sangre , Anticonvulsivantes/efectos adversos , Epilepsia del Lóbulo Frontal/tratamiento farmacológico , Trastornos Neurológicos de la Marcha/inducido químicamente , Hiperamonemia/inducido químicamente , Ácido Valproico/efectos adversos , Accidentes por Caídas , Adulto , Anticonvulsivantes/uso terapéutico , Progresión de la Enfermedad , Epilepsia del Lóbulo Frontal/sangre , Femenino , Trastornos Neurológicos de la Marcha/sangre , Humanos , Hiperamonemia/sangre , Masculino , Ácido Valproico/uso terapéuticoRESUMEN
High levels of fibrinogen, factor (F) VIIc, plasminogen activator inhibitor-1 (PAI-1), and plasma viscosity are associated with an increased coronary risk. As positive correlations of these parameters with triglycerides have been shown, the increased coronary risk associated with high levels of triglycerides may be assumed to be due to alterations within the hemostatic system. To reduce the coronary risk to which hypertriglyceridemic patients are exposed, dietary treatment is recommended; the optimal composition of such a diet is, however, a matter of debate. With regard to the effects on hemostasis, we compared in a sequential approach two diets for treatment of 25 nonobese male patients (age, mean+/-S.D., 40.4+/-8.7 years) with fasting triglycerides >2.3 mmol/l. The first diet (high fat) was rich in monounsaturated fatty acids (MUFA) and marine n-3 polyunsaturated fatty acids (PUFA), whereas the second diet (low-fat) was rich in complex carbohydrates and dietary fiber. The high-fat diet induced a significant lowering of FIIc, FIXc, FXc, FVIIc, FVIIa, FXIIa, PAI-1, plasma viscosity, and platelet activity, but led to an increase in fibrinogen, whereas the low-fat diet lowered FXIIc values and induced a nonsignificant decrease in fibrinogen. Probands on this diet had a slightly higher FVIIa and platelet activity than those on the high-fat diet. However, as all changes appeared to be within the normal range of each hemostatic parameter, it remains to be clarified whether the likely beneficial effects of the high-fat diet on most hemostatic factors are outweighed by the small increase in fibrinogen levels.
Asunto(s)
Dieta con Restricción de Grasas , Grasas Insaturadas en la Dieta/uso terapéutico , Ácidos Grasos Monoinsaturados/uso terapéutico , Ácidos Grasos Omega-3/uso terapéutico , Hemostasis , Hipertrigliceridemia/sangre , Hipertrigliceridemia/dietoterapia , Adulto , Factores de Coagulación Sanguínea/análisis , Índice de Masa Corporal , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Grasas de la Dieta , Ácidos Grasos Monoinsaturados/administración & dosificación , Ácidos Grasos Omega-3/administración & dosificación , Ácidos Grasos Omega-6 , Ácidos Grasos Insaturados , Humanos , Masculino , Triglicéridos/sangreRESUMEN
Various studies have already shown that the fatty acid composition of dietary fat has different effects on hemostasis and platelet function. However, knowledge on this topic is incomplete. In the present study, fifty-eight healthy students received either a 4-week rapeseed oil [high content of monounsaturated fatty acids (MUFA) and high n-3/n-6 PUFA ratio], an olive oil (high content of MUFA, low n-3/n-6 PUFA ratio) or a sunflower oil (low content of MUFA, low n-3/n-6 PUFA ratio) diet. In each group, effects on hemostatic parameters were compared with a wash-in diet rich in saturated fatty acids with respect to intermediate-time effects on the hemostatic system and platelet function. With the olive oil diet, a reduction of coagulation factors VIIc, XIIc, XIIa, and Xc was found, whereas sunflower oil led to lower values of coagulation factors XIIc, XIIa, and IXc. In all study groups levels of plasmin-alpha2-antiplasmin were lower in week 4 than at baseline. Lower fibrinogen binding on platelets was found after the sunflower oil diet, whereas expression of CD62 and spontaneous platelet aggregation were slightly higher after the olive oil diet. However, given the major differences in the fatty acid compositions of the diets, the differences between the groups with respect to hemostasis tended to be small. Therefore, the clinical significance of the present findings remains to be evaluated.
Asunto(s)
Grasas Insaturadas en la Dieta/farmacología , Hemostasis/efectos de los fármacos , Aceites de Plantas/farmacología , Adulto , Factor VII/efectos de los fármacos , Factor XII/efectos de los fármacos , Ácidos Grasos Monoinsaturados/farmacología , Ácidos Grasos Omega-3/farmacología , Ácidos Grasos Omega-6 , Ácidos Grasos Insaturados/farmacología , Femenino , Humanos , Masculino , Aceite de Oliva , Pruebas de Función Plaquetaria , Aceite de Brassica napus , Aceite de GirasolRESUMEN
PURPOSE: To present a photographically documented case of a known brown recluse spider bite to the eyelid. DESIGN: Interventional case report. METHODS: The wound was photographed daily during an 11-day hospitalization and at 1 month and 6 months after the injury. Treatment included canthotomy and cantholysis; administration of dapsone, antibiotics, and steroids; and hyperbaric oxygen therapy. MAIN OUTCOME MEASURES: Clinical presentation and course of a known brown recluse spider bite. RESULTS: Complete recovery with cicatrization at the site of the bite. CONCLUSIONS: We present a case of a brown recluse spider bite to the left lower eyelid with a discussion of management and outcome of this rarely reported injury.
Asunto(s)
Lesiones Oculares/etiología , Párpados/lesiones , Picaduras de Arañas/complicaciones , Arañas , Animales , Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Niño , Dapsona/uso terapéutico , Lesiones Oculares/patología , Lesiones Oculares/terapia , Párpados/patología , Femenino , Humanos , Oxigenoterapia Hiperbárica , Metilprednisolona/uso terapéutico , Picaduras de Arañas/patología , Picaduras de Arañas/terapiaRESUMEN
Cerebellar and thalamic stimulation has been known for many years to improve control of epileptic seizures. In the past few years electrical vagus nerve stimulation (VNS) has been introduced and has been effective in controlling seizures in animal models. These encouraging results led to the development of a transcutaneous programmable pulse generator and electrode lead for human use. 2 pilot studies and a multicenter, prospectively-randomized, parallel, double-blind study of patients with refractory partial seizures were performed. In a 3-22 month follow-up, in about 50% of patients seizures were reduced by 30-50%. There were no significant complications of the implant. Side-effects associated with VNS included intermittent hoarseness, coughing and throat pain. Additional controlled clinical trials with many patients and long follow-up are needed. We report 2 patients, the first in Israel, who underwent VNS.